Mark Alan Logan, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95013193 Issued in CA

Practice address

538 N Detroit St
Los Angeles, CA 90036-1949

Phone

(310) 751-1080

Fax

(844) 941-1989

NPI assigned

Jul 24, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Psychiatric/Mental Health

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1780107433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 N DETROIT ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900361949",
            "telephone_number": "310-751-1080",
            "fax_number": "844-941-1989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "538 N DETROIT ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900361949",
            "telephone_number": "310-751-1080",
            "fax_number": "844-941-1989"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2750 E Washington Blvd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Pasadena",
            "state": "CA",
            "postal_code": "911071449",
            "country_code": "US",
            "telephone_number": "626-296-8900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-24",
        "last_updated": "2024-03-26",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95013193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Swanson Logan, AMFT
• Kelly Logan
• Lauren Logan
• Le Shaunte Logan, ACSW
• Lindsey Logan
• Montana Logan
• Paisley Logan
• Robert James Logan
• Tina Ann Logan Sr., MFT INTER
• Janice Ellen Loggins, AU.D.

• Psychiatric/Mental Health Nurse Practitioner in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.